Oriental Medicine (OM) is a comprehensive system of health care based on a detailed understanding of how Qi, or life energy, circulates through the body and determines health or illness. OM employs a variety of methods to restore or maintain proper balance and harmony in the circulation of Qi (also spelled chi).
History
Oriental Medicine comprises several related approaches to healing with roots dating back more than 5,000 years. Though distinct styles and practices have evolved in different geographic areas, most trace their primary inspiration to the Huang Ti Nei Ching Su Wen (The Yellow Emperor’s Classic of Internal Medicine), a text from about 200 B.C. usually known for convenience as the Nei Ching.
However, what is now known as "Traditional Chinese Medicine" (TCM) is to some extent an artificial construct. After the Communists took power in 1949 and later during the Cultural Revolution, they codified and streamlined Chinese medicine. Though most extant treatment methods that fall under the TCM rubric do date from ancient China, many OM techniques spread to other places well before the mid-1900s. These flourished in the medical practices of countries as disparate as Taiwan, Japan, Korea, and France, even as they died out or were deemphasized in mainland China. As a result, OM practitioners in the West now have an unusually rich array of traditions from which to choose.
Foundations
As noted, OM is based on the creation of balance between all the forces in an individual’s life, physical, emotional, and spiritual, and as a result could be called the original holistic medicine. OM practitioners emphasize the importance of evaluating and treating all these aspects of a patient. To do otherwise would mean merely treating symptoms rather than root causes (indeed, it is a sly insult in OM to suggest that another practitioner is treating symptoms).
For many practitioners, the root of OM healing technique lies in Qigong, a Chinese technique that can be translated as "energy skill." Qigong contains three primary emphases or schools: medical, martial, and spiritual.
Spiritual Qigong is the oldest (and many would say, ultimate) approach. Practiced primarily in the Daoist tradition, spiritual Qigong aims to unify the life energy of the practitioner with that of the universe itself, leading him or her to Enlightenment. Inherent in spiritual Qigong and its goal (which one practitioner describes as "transcendent integration") is the emphasis on living a simple, harmonious, and virtuous life according to natural principles.
Martial Qigong, as expressed in itself or in related arts such as Tai Chi, utilizes the body’s energy system to become impervious to blows, or to deliver devastating strikes to opponents, sometimes without even touching them. In its more refined state, martial Qigong also leads practitioners to a finely tuned intuition that allows them to anticipate their adversaries’ actions.
This type of sensitivity is further refined and put to different use in medical Qigong, wherein the practitioner uses his or her own skill with energy to help balance and strengthen that of the patient.
In Qigong, though, all roads lead to Rome (or rather Beijing). Even texts about martial Qigong ultimately stress the importance of transcending harmful intent. Many practitioners gain skill in all three "schools" of Qigong simply because of the profound nature of the understanding acquired. They may emphasize different aspects of it in varying circumstances, but ultimately any Qigong practice centers on tapping and using universal energy.
The many branches of OM spread extravagantly from this solid trunk of Qi, but they all draw their guiding principles from it. Aspects of Oriental medical approaches include:
Qigong healing
acupuncture
massage
herbal therapies
dietary therapies
The goal is to use any of these approaches, or appropriate combinations of them, to unblock, strengthen, and balance the patient’s Qi as it moves through the body’s energy pathways (known as meridians) and organ systems.
Approaching a Diagnosis
In OM, deficiencies, imbalances, stagnation, or blockages in Qi circulation are believed to cause illness. To attain maximal health, individuals must establish equilibrium between a number of forces in their lives. These may include the constituents and organ systems; the person and his/her social and physical environments; the eight principles (four pair of complementary opposites, yin/yang, interior/exterior, hot/cold, and full/empty); and the five phases. Often translated as the five elements, these describe aspects of the way energy circulates and manifests in the body; they also imply relationships between the body and the outer world. The practitioner must consider all of these factors in making a diagnosis and arriving at appropriate remedies.
In Chinese medicine, diagnosis is typically made on the basis of symptom, sign, and complex. Symptoms are the patient’s complaints; signs are what the practitioner discerns based on conversation, pulse diagnosis, palpation, examination of the tongue, and so forth; the complex is then identified as the patient’s pattern and how it manifests. Different aspects of this diagnostic methodology receive more or less emphasis in other varieties of OM.
The Five Phases
Because the five phases are central to any discussion of OM, a summary of their characteristics may be helpful. The phases, wood, fire, earth, metal, and water, are associated with emotions, organs, seasons, tastes, and even colors. Because the phases and their various interactions can be mind-boggling in their complexity, here we will simply outline them along with certain predominant associations.
It is important to recognize, however, that in such categories OM generally refers to energetic systems that may correspond only loosely to the physical organs from which they take their names. Even to the untrained, however, certain associations are helpful. For example, in the metal phase, the yin organ is the lung, and in OM autumn is considered a time when the lungs tend to be weak and must be guarded against infection and disease.
Wood (perhaps better translated as tree, or new growth) corresponds to spring. The yin organ is the liver; the yang is the gallbladder. Wood corresponds to an ability to make plans and express emotions in a healthy way.(1) An imbalanced wood phase can result in frustration, anger, anxiety, and various physical manifestations.
Fire corresponds to summer. The yin organ is the heart; the yang is the small intestine. Fire relates to expansiveness, enthusiasm, warmth, and relaxation. When the fire phase is out of balance the result can be depression, doubt, lack of energy, digestive problems, and heart disease.
Earth corresponds to Indian summer. The yin organ is the spleen; the yang is the stomach. Earth relates to nourishment, contentment, harvesting, empathy, and caring. Imbalance in the earth phase may be associated with obsession, self-centeredness, and insecurity, or with physical symptoms such as gastrointestinal disease.
Metal corresponds to late summer. Its yin organ is the lung; the yang organ is the colon. Metal relates to internal resolve, self-esteem, vitality, and endurance. When out of balance, the result may be depression, rigidity, or emotional withdrawal, with physical symptoms including asthma, eczema, or constipation.
Water corresponds to winter. Its yin organ is the kidney; the yang is the bladder. Water relates to courage, willpower, trust, and faith. Imbalance may lead to fear, fatigue, and timidity, with endocrine disorders, infertility, and hypertension manifesting physically.
OM Treatment Modalities
Once the OM practitioner has arrived at a diagnosis, treatment may take a variety of forms depending on both the practitioner’s preferences and the patient’s propensities and needs. The foundation of all therapy is, again, the balancing of the patient’s energies, whether through Qigong, diet, herbal therapy, massage, acupuncture, or a combination of these modalities.Here we will briefly discuss each of these modalities, including, where appropriate, variations or differing schools of thought.
Dietary Therapy
It’s understood in OM that if patients have digestive disorders that inhibit their absorption of foods and nutrients, those problems should be addressed as soon as possible. A patient with irritable bowel syndrome and heart problems might need herbs for the cardiac condition, but if the body can’t first be balanced by controlling diarrhea, herbal therapy will be of limited utility. Some OM practitioners believe that first treating the earth (digestive) phase allows other problems to be resolved much more easily.
Foods and herbs alike are assessed in terms of their taste as well as the meridians and organ systems they affect. Generally, foods may be used to help cure illnesses or to tone the body depending on the seasons and the phases associated with them. For example, foods recommended for autumn would strengthen the respiratory system. Their energy should be cool, cold, or warm; their taste, sweet or sour. Healthful autumn foods include apples, bamboo shoots, barley, clams, eggplant, spinach, and wheat bran.
Herbal Therapy
Herbal therapy is considered an important adjunct to other modalities in most of OM. Typically, anywhere from two to thirty herbs are combined in a formula, not only to address what may be complex problems, but also to both potentiate and moderate each other. Most practitioners prefer to rely on raw herbs or concentrated powders, though herbs may also be prepared as tinctures (alcohol-based extracts) or in capsules (preferably freeze-dried). OM practitioners stress the importance of using credible suppliers to ensure herbs’ identity, quality, and purity. Problems with adulteration have diminished enthusiasm for Chinese patent medicines (i.e., those that come in premixed formulas) unless their manufacturers are known to be reputable.
Chinese Herbology classifies herbs and other therapeutic natural substances in a variety of categories related to their effect on the body’s Qi and related energies. For example, some herbs categorized as Regulating the Qi are useful in dealing with digestive disturbances where the Qi’s direction is said to be misdirected such as in burping and indigestion.
Qigong Healing and Massage Therapy
Massage therapy in OM is founded on an ancient Chinese technique called Tui Na. According to a modern Tui Na practitioner, this approach was the fountainhead for almost all other varieties of massage worldwide.(2)
Tui Na in its purest form is rooted in Qigong healing, that is, the practitioner’s use of Qi to unblock, strengthen, and concentrate Qi in the patient’s meridians, usually accessed via acupuncture points. Medical Qigong therapy may include teaching patients exercises to move the energy on their own. For instance, a woman suffering from painful menstruation may learn to practice movements that release stagnation in the lower abdomen and pelvic region.
Tui Na also contains powerful techniques to manipulate joints, work muscle and deep tissue, and gain access to organ systems through points in the soles of the feet.
Those familiar with other massage techniques may recognize their origins here. For example, Japanese practitioners visited China for two years during the sixth century and learned Tui Na’s meridian techniques, which then became Japanese shiatsu, or acupressure massage.
It has also been reported that French and Swedish practitioners were influenced by Chinese practices in the development of what we now typically call Swedish or therapeutic massage; some may also have learned to use the meridians on the soles of the feet in what became Reflexology. Chiropractic, developed by David Palmer in the late 1800s, shares some techniques for manipulating bones and joints with Tui Na and with similar ancient practices from Mediterranean civilizations. Other Tui Na techniques exist for treating children and pregnant women, and for concentrating on internal organs.
Acupuncture
The theory and practice of acupuncture are discussed in depth in the "Acupuncture" article. Essentially, acupuncture uses points on the body’s meridians to stimulate, modify, and regulate the flow of Qi. Over the centuries, practitioners have developed sophisticated diagnostic and treatment techniques involving the eight principles, the five phases, and other systems. Acupuncturists typically use complex patterns of points to move Qi in certain ways, depending on their own training, expertise, and orientation.
Different schools emphasize different approaches, but it is probably safe to say that there are as many schools of acupuncture as there are acupuncturists. It is interesting that in one study, practitioners from different backgrounds used widely varying methods to diagnose patients, but nevertheless ended up employing roughly 70 percent of the same points in treating them, probably about the correlation that would exist if those practitioners had all come from the same school.
Numerous approaches exist in the world today. The most common is the TCM approach learned by licensed acupuncturists in schools of OM, both in the United States and in other countries. In addition, several other schools are worth noting:
Korean Acupuncture
This tends to be the most physically vigorous method in terms of needling technique (size of needles used, depth of penetration, and stimulation). Practitioners of Korean acupuncture may also learn a technique of hand acupuncture pioneered by Dr. Tae-Woo Yoo and first taught in the United States in 1987. According to a U.S. physician who uses the technique, in this system the hands are seen as containing a point-by-point parallel to the body’s acupuncture points. Advantages of the hand system are easy accessibility and a strong sensitivity that allows treatment with either very small, fine needles or no needles at all. In the latter approach, the practitioner uses a small metallic ball (typically of gold, silver, or stainless steel, and roughly 1 mm in diameter), which is taped in place over the point to stimulate it. Alternatively, practitioners use direct electrical stimulation of the hand acupoint with a weak electrical current.
Japanese acupuncture
Japanese acupuncture favors fine, sharp needles to reduce or eliminate the pain sometimes associated with the broader, round-tipped variety often used by Chinese or Korean practitioners. As developed and promulgated by Kiiko Matsumoto LAc, Japanese acupuncture also emphasizes palpation of the body along with the more common technique of wrist palpation to assess the pulses. In evaluating the body, Japanese practitioners primarily palpate the abdomen, followed by the throat, neck, and back, in the belief that these areas tend to reflect different pathologies.
Five Element Acupuncture
The Five Element approach is based on the theory of the five phases and was first promulgated in the West by Dr. J.M. Worsley. It seeks to understand illness in the context of the five phases described earlier, and to devise treatment methods incorporating the knowledge of how the phases interact, both within the individual and between him or her and the environment, in a practical way. Five Elements acupuncture stresses the importance of assessing a patient’s whole self, body, mind, and spirit, and treating on all three levels. One practitioner states the goal of the Five Elements approach as to "reach the level of the constitutional imbalance or causative factor and not focus on treating a symptom or syndrome."(3)
Medical Acupuncture
Sometimes called French Energetics, medical acupuncture is based on a system brought from China to France, first by returning Jesuit missionaries as early as the 1600s, but primarily in the 1920s by the French ambassador to Shanghai, Soulie DeMaurant. Members of the French neurological society were captivated by the obvious efficacy of acupuncture and began to study and use it in the context of emerging knowledge about anatomy and physiology in the Western biomedical model. Essential to the practice of medical acupuncture is a diagnostic system that uses trigrams and hexagrams from the I Ching. Practitioners of medical acupuncture in the U.S. are usually physicians who use it as an adjunct to their existing practices.
For more on the regulation of acupuncture in the U.S. see this important article.
The introduction of medical acupuncture to the United States, primarily through a continuing medical education (CME) course offered by UCLA, has met some resistance by the TCM community, which tends to view the training as comparatively short and superficial.
Physician-acupuncturists respond that a substantial portion of the education of LAcs consists of anatomy and physiology (which the physicians have already covered in medical school) and herbology ( which the physicians usually don’t practice). They stress that the CME approach is intended to provide an overview of available techniques, and that doctors are encouraged to study more deeply those with which they feel an affinity. They point out further that due to the nature and heritage of the French approach, they often learn techniques that did not survive the Cultural Revolution and hence are unavailable to those who study in traditional TCM schools.
In the best of cases, however, physicians who practice medical acupuncture sometimes share office space with LAcs, to the broadening of both and the benefit of their patients. One medical acupuncturist feels that the TCM approach is especially helpful in treating chronic conditions in internal medicine, while medical acupuncture seems more efficacious in pain control. Some doctors are even hybrids; they are MD/LAcs, who enjoy the depth and breadth of both traditions.
Who Practices Oriental Medicine and What is Their Training?
As already described, both physicians and LAcs practice acupuncture, though LAcs are far more likely to augment those treatments with herbal and dietary therapies. OM programs in the United States generally require about 2,000 hours of class and clinical time, take three or four years to complete, and culminate in supervised practice. The Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) accredits the schools, though not all have yet received accreditation. Licensing varies by state; indeed, in some states LAcs may only practice under the supervision of a physician.
For physicians practicing medical acupuncture, the standard CME course involves about 200 hours, much of it home study using texts and videos. Upon completing their training, physicians usually opt to join the American Association for Medical Acupuncture (AAMA).
Is Oriental Medicine Safe?
Adverse Effects
Chinese herbal therapy generally has few side effects if used properly. However, herbs can be powerful and even toxic if used inappropriately. As mentioned, there are also reported instances of Chinese patent medicines being adulterated with toxic chemicals, metals, or Western drugs. Finally, although little is known about interactions between herbs and Western drugs, more practitioners are learning about potential problems. In any event, it is clearly critical to work with a practitioner who is well trained in OM when herbal therapy is employed.
Serious adverse effects of acupuncture are rare and generally associated with inadequate sterilization procedures, or inadvertent penetration of the body cavities or organs. The introduction of sterile, single-use, disposable needles has drastically reduced the threat of infection, especially now that they have been adopted by almost all acupuncturists. Always ask your practitioner about sterilization and whether he or she uses disposable needles.
Contraindications
The primary contraindication for Chinese herbs is the concurrent use of over-the-counter or prescription drugs, for which the possibility for unsafe interaction is not known
Acupuncture should not be used, or used with caution, under the following circumstances:
People with heart valve diseases or who have artificial heart valves should not have ear studs placed due to an increased risk of heart valve infection (endocarditis).
People who are taking anticoagulant medications such as warfarin or who have uncontrolled bleeding disorders
Pregnancy (certain acupuncture points only, or with electroacupuncture in general)
People who have breast or other implants should not have needles placed in the area of the implant
Presence of a pacemaker or automatic defibrillator (electroacupuncture only)
Abnormal heart rhythm (electroacupuncture only)
What to Expect in a Practitioner’s Office
The initial visit typically begins with a diagnostic interview in which the practitioner takes a general health history as well as an in-depth description of the condition for which the client is seeking treatment. As already described, diagnosis is based upon identifying the signs and symptoms that reflect the balance or imbalance of the person’s internal organ systems as well as his or her Qi. Assessment of pulses at the wrist, examination of the tongue, or palpation of the abdomen may help the practitioner determine the condition of the body’s organ systems and Qi.
Treatment often involves the combination of acupuncture and herbal medicine. Acupuncture usually takes place with the patient lying on a table; some practitioners further stimulate the point by gently twisting the needle, applying a weak electrical current, or adding moxibustion (using the smoldering herb moxa (artemesia vulgaris) to warm the acupoints). Depending on the practitioner, the patient, and the treatment style, needles may be left in place for anywhere from 15 minutes to two hours.
In many cases, patients should plan to schedule a series of sessions to fully address the problem. Often these visits decrease in frequency over time, though the use of herbs may continue daily.
Cary Groner and William Collinge, Ph.D., M.P.H.
Notes
1. These descriptions are from personal communications and from Moss C. Five Element acupuncture: Treating body, mind, and spirit. Alternative Therapies in Health and Medicine 1999; 5(5):52-61.
2. Personal communication from Dr. Alex Chen.
3. Moss, pp. 60-61.
Additional references used
Lytle C. An Overview of Acupuncture. Washington, D.C.: U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration, Centers for Devices and Radiological Health (monograph, 1993).
Vincent C. A controlled trial of the treatment of migraine by acupuncture. Clinical Journal of Pain; 5(4):305-12.
Loh L, et al. Acupuncture versus medical treatment for migraine and muscle tension headaches. Journal of Neurology, Neurosurgery & Psychiatry; 47(4):333-7.
Coan R, et al. The acupuncture treatment of low back pain: A randomized controlled study. American Journal of Chinese Medicine; 8(1-2):181-9.
Zeisler H, et al. Influence of acupuncture on the duration of labor. Gynecol Obstet Invest; 46(1):22-5.
Acupuncture. NIH Consensus Statement Online; November 1997.
Sun Y. The role of traditional Chinese medicine in supportive care of cancer patients. Recent Results in Cancer Research; 108:327-34.
Bensoussan A, et al. Treatment of irritable bowel syndrome with Chinese herbal medicine: A randomized controlled trial. JAMA; 280(18):1585-9.
Cardini F, Huang W. Moxibustion for correction of breech presentation: A randomized controlled trial. JAMA; 280(18):1580-4.
Sancier K. Therapeutic benefits of Qigong exercises in combination with drugs. Journal of Alternative and Complementary Medicine, 5(4):383-9.